The Diagnosis, Treatment And Prognostic Factors Analysis Of Moyamoya Disease

ObjectAnalyzed MMD patients with conservative treatment and surgical treatment to understand the efficacy of the two treatments as well as the applicability of different surgical methods and analysis of prognostic factors, to provide a frame of reference for moyamoya disease treatment options.Materials and MethodsRetrospective analysis of Xiangya Hospital neurosurgery and pediatric admitted on January1,2010to2012,10patients with moyamoya disease (moyamoya disease, MMD) the patient’s medical records and imaging data, and its follow-up observation.10patients in seven cases for adults (male to female ratio is3:4), children3cases (patients were male) Adults:Children ratio of7:3,6males,4females, the male to female ratio of3:2, The median age of patients was23.5years (range2-56years). Due to the onset of intracranial hemorrhage in7patients (moyamoya disease, bleeding in4cases, including children;2cases of bleeding associated with arterial aneurysm,1patient with pseudoaneurysm bleeding), two cases of children (repeated visits to hospital3) and female adults (hospital) manifested as symptoms of cerebral ischemia. All rows in the patients with moyamoya disease related surgery in4cases, conservative treatment and surgery-related cases. Analysis of patients with or without physical activity and language barriers, immune disease history, history of trauma, with or without hypertension, diabetes, lung infections, heart disease, smoking, drinking history, associated with aneurysm and intracranial vascular malformations, cerebral vascular accident and cerebral hemorrhage, site, bleeding, the number of bleeding, the presence or absence of postoperative complications (cerebral hemorrhage, cerebral infarction, epidural or subdural effusion, stress ulcer, pulmonary infection, psychiatric symptoms, headache, seizures, electrolyte imbalance, hydrocephalus, visual field changes, language barriers, nerve damage, disturbance of consciousness, tracheostomy, wound infection), coma, death, postoperative recovery of neurological function, mRS score, degree of symptoms, postoperative patient’s condition without recurrence, the relationship between surgical options and efficacy and patient age, the cost of treatment of patients, length of stay. Completion of the data collection and analysis, reference moyamoya disease treatment options and prognosis. Phone, outpatient follow-up letters were followed up for2-31months.ResultThere are5Moyamoya disease in surgical group, including2children and1adult female patients EMS to surgery (1case of children Preoperatively cast ventricle has been in double lateral drainage), two cases of adult Women line superficial temporal artery-middle cerebral artery anastomosis (one cases of patients with temporal muscle attached to the surgery, the other cases combined line multiple intracranial aneurysm the+saddle area placeholder resection), postoperative subdural hemorrhage, effusion, product gas four cases, pulmonary infection in1case,1case of aphasia, electrolyte imbalance, hypoalbuminemia one cases, fever four cases, headache in4cases, tracheotomy patients, hydrocephalus one cases (but without surgical treatment), after discharge patients died due to deterioration of the general condition. Modified Rankin Scale (mRS score)0-2in1case,3-6points in4cases, follow-up of patients after discharge5.The remaining5patients take the conservative medical treatment and other related surgery, and1case of children admitted to hospital due to ischemic symptoms with medications (total of3times the hospital for observation therapy), more than4adult patients underwent surgical treatment related a routine intracranial aneurysm surgery, the routine false aneurysm resection,1patient with basal ganglia hemorrhage hematoma and some craniectomy decompression,1patient with intraventricular mold line double lateral drainage. Conservative medical treatment after treatment in children with limb weakness, psychiatric symptoms and seizures better than before, more than four cases of surgical patients with postoperative tracheotomy two cases, intracranial hemorrhage in1case again and eventually die, bacteremia and eventual death, hypoalbuminemia2cases,2cases of stress ulcer, long-term coma patients, psychiatric symptoms in1case, the modified Rankin Scale (mRS score)0-2in1case,3-6points4cases. Patients were followed up after discharge5.ConclusionChoose the appropriate surgical approach in the treatment of patients with recurrent ischemic symptoms should be early surgery and combined with drug therapy, the onset of bleeding patients to be in stable condition after.Patient age, preoperative mRS score, TIA (transient ischemic attack) attack frequency, the number of preoperative bleeding, postoperative cerebral infarction and intracranial bleeding may be risk factors associated with prognosis.